Two-Stent Strategy? Which One to Choose? First Case Example

Abstract

Optimal treatment of bifurcation lesions is still a major challenge for coronary intervention. A planned two-stent approach may be more appropriate when both the parent vessel and side branch (SB) are large, and when there is significant disease distal to the ostium of a SB that arises from the main vessel at a shallow angle. A simple, provisional stenting approach that is associated with shorter fluoroscopy time, lower incidence of periprocedural myocardial infarction, and similar rates of target-vessel revascularisation compared with a routine two-stent strategy is needed. The combination of a biovascular scaffold and drug-eluting stent implantation as a two-stent technique using a ‘mini-crush’ technique is a safe, feasible, effective, and durable treatment option for patients with true bifurcation disease. Patient selection for complex stenting requires accurate lesion evaluation. Our current institutional recommendations are to use provisional stenting in the majority of cases, but if a planned two-stent approach is required, we recommend the use of imaging methods, plaque modification before stent implantation, final kissing balloon, and proximal optimisation inflation technique to achieve good final results.